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Doctor’s orders: raise the minimum wage

The first time I met Raj, I remember feeling completely helpless in what to offer him. A middle-aged South Asian man with a wife and two kids, Raj had moved to Canada looking for a better life 7 years ago. He came to the clinic looking for help, but what ailed him was more complicated than a headache or a twisted ankle. Raj told me that although he had previously held a “good job” in his home country, he was unable to find similar work in Canada. Instead, he took work wherever he could find it but his paycheck just wasn’t cutting it. Raj found himself stuck between his family in Canada that needed to survive, and extended family back home expecting him to send them money.

Soon after arriving, Raj started having difficulty coping with the stress of it all. As a result, the relationship with his wife slowly started to break down. Eventually his wife asked for a divorce, telling him that he had failed in his role to provide for the family. With nowhere to go, Raj turned to a shelter, where he stayed for almost a year, while continuing to work full time making poverty level wages. The stigma of poverty, homelessness and the breakdown of his marriage was so great that Raj felt unable to reach out to family members back home for support. He avoided socializing with community members in Canada who may have had links to his relatives, in the event that they would learn of his situation.

Raj was having difficulty sleeping, carrying intense feelings of hopelessness and worrying constantly. He came to me to find answers, to feel better, to be cured. By all definitions of the term, Raj was experiencing clinical depression. It would have been easy to give him this diagnosis, prescribe him an antidepressant, and hope that his problems would be solved. But having heard Raj’s story, I knew that his feelings were a consequence of his social situation, and anything I could offer would be a band-aid solution. The underlying problem was that he was living in poverty.

This story is unfortunately a common one. In 2008, 400,000 Canadian adults found themselves below the poverty line, even while working full-time, because they made less than $10/hour. For the past three years, the minimum wage in Ontario has been frozen at $10.25/hour, putting full time minimum wage workers 19% below the poverty line. Recently, rising income inequality has become a mainstream topic of discussion. Since the 1980s, workers’ wages have stayed almost the same while incomes in the top 1% have grown by 71%. When it comes to income inequality, Canada is ranked 12th out of the 17th richest countries of the world. We have a long way to go.

We also know that living in poverty is not just an economic and political issue, but fundamentally an issue of human health. Income is the strongest determinant of health. How much you make is more important than what you eat, how much you exercise, or even your genetic make-up. A recent series of articles in the Ontario Medical Review highlights the fact that poverty is a medical problem, and healthcare providers are seeing the impacts on the front lines. We know that people on social assistance have a suicide rate 18 times higher than those in the highest income bracket. We know that people living in poverty have higher rates of diabetes, heart disease, arthritis, and even cancers. Worst of all, we know that the rate of death among infants is 60% higher in our lowest income neighbourhoods.

Do we want to live in a society where we accept that people living in poverty will have a higher risk of losing their children, getting cancer and taking their own lives than those who have more? It seems to me, when thinking of Raj and so many others I have met just like him, that raising the minimum wage enough so that no one working full time would have to live below the poverty line is a basic first step. Perhaps in this situation, Raj would have been able to better support his family and avoid slipping into depression. With a higher income, he could be healthier overall.

People are coming together all across Ontario to raise the minimum wage to $14/hour, with actions happening on the 14th of each month. Try as I might, I know that what I have to offer as a doctor is a small piece of the puzzle. Comforting words and prescriptions might help, but at the end of the day, what we need is systemic change. It’s time to prescribe something that works: an increase in the minimum wage.

Ritika Goel is a family physician and public health professional working with marginalized populations in Toronto. Follow Ritika on Twitter @RitikaGoelTO.

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11 comments

Aisha KhanJanuary 14th, 2014 at 9:53 am

Excellent article. The problem also mainly lies in our education system and HR hiring policies demanding ” Canadian experience” this substantially affect the educated masses who come from back home and cannot find jobs in their respective fields. Not that they lack expertise but only because of the stuck up hiring policies . I personally have HIRED my office staff who were new immigrants to this country and they did not have to learn the ropes in any Canadian schools and they are on a starting salary more than the current min wage, hated to have turned them away because they lack ” Canadian Experience” ? I believe with the appropriate training the educated immigrant can launch into a decent career .There is no need for them to spend outrageous fees to seek admissions into ” Canadian schools” get an OSAP ( scam) loans and then ” TRY” to find a job … end results ? End up in a Tim Horton’s coffee shop or a factory warehouse with min wage . So we are back to square because the very root cause of evil lies in our hiring policies . Nice to raise the min wage but who will change the hiring policies of banks, corporate houses and healthcare industry ? We all hope the min wage of $14 / hr see the day soon and thus begin the avalanche of salary change in every industry thereafter.

“How much you make is more important than what you eat, how much you exercise, or even your genetic make-up. A recent series of articles in the Ontario Medical Review highlights the fact that poverty is a medical problem, and healthcare providers are seeing the impacts on the front lines. We know that people on social assistance have a suicide rate 18 times higher than those in the highest income bracket. We know that people living in poverty have higher rates of diabetes, heart disease, arthritis, and even cancers. Worst of all, we know that the rate of death among infants is 60% higher in our lowest income neighbourhoods.”
Correlation is not causation.

Increasing wages also results in less jobs. So maybe a Tim Hortons franchise owner who had 15 employees can now only have 10 to make the business still work. Another problem is higher wage costs being passed onto customers.

My donut might cost a few cents more, but if raising the minimum wage reduces demand on the health care system, maybe I can see my physician sooner when I’m unwell, and my provincial taxes won’t increase as fast: that’s an OK tradeoff for me!

Hello Mike
Maybe minimum wage policies are not just a redistributive economic poverty reduction policy as framed by this debate. As with most things people, businesses and governments are far more than just their wallets living their live based on economic theories. This also needs to be considered in such debates.

For many minimum wages primarily reflect a basic lower limit to the cost of human resources that society will accept in order to prevent the disadvantaged from being exploited – whether or not they live in poverty. In other words a socially acceptable minimum ROI (Return on Investment) for peoples time when working in Canada. It is intended to impact the types of jobs in Canada … our challenge is in creating enough valuable jobs and let people actually do volunteer work and community service in areas where true value is provided without consideration of wages paid.

As you identified in your own opinion paper there are other measures and policies that may contribute to an overall policy framework that will address the issue of unacceptably high and growing poverty levels in Canada. Some countries (Switzerland) are experimenting with the negative income tax model proposed by yourself and Gobi K. It will be one option to explore further. On the other hand, as demonstrated by a longitudinal study of 185 countries wage policies undertaken by a United Nations agency comprised of employees, employers and government representatives Canada has relatively low minimum wages amongst the higher income countries. You concede that Australia and some studies in the US provide examples were minimum wage policies may not have a negative effect on employment levels or at best are inconclusive … clearly there are far more factors at play in this dynamic than two policy considerations.

So like most things we are looking to balance the many interests of individuals, employers, governments and broader society to ensure basic human dignity is maintained for all while also addressing the issues of unacceptable and growing levels of poverty in Canada. This will take more than one or two policies to actually address … it will require the best from all of us to reconcile … it will require an openness to work with others to find a sustainable solution for Canadians … individuals, businesses, governments … more work to be done.

Mike you could also go the other way and have wages of $1.25 a day as some parts of the world experience.

Probably the answer derived will please the least number of people as it will require people compromising on all sides of the debate … employees … employers … economists … with the government in the middle brokering policies that allow basic economic and social standards to be met in Canada.

There needs to be a fix of some sort, but would be far more complicated than merely increasing the minimum wage.

The biggest problem at this present time is not the minimum wage but a welfare system that encourages perpetual dependence on the system.

I would much prefer an increase in minimum wage if money was diverted from our welfare system to businesses so that they could absorb the cost while giving people gainful employment and income that allows for some semblance of financial security.

Most economists agree that a minimum wage pushes some people out of the labour market (it’s important to realize we’re not just talking about those who would become unemployed at $14/hour, there are also those who are already unemployed at $10.25/hour. As the manager of a small charity we would like to hire a summer student, but even at $10.25 an hour it’s hard to find the money, at $14 an hour it would be impossible.

This document is provided under the terms of a CreativeCommons Attribution Non-commercial Share Alike license. The terms of the license are available at: http://creativecommons.org/licenses/by-nc-sa/3.0/. Attributions are to be made to HealthyDebate.ca, a project under the direction of Dr. Andreas Laupacis, at the Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael’s Hospital.